Simple or first infection

Once a UTI is suspected, the treatment is an empiric course of antibiotics. The length of treatment has shortened from ten days to one to five days (Table 21.7).

Table 21.8 Single-dose treatment for simple urinary tract infection

Drug

Dose

Amoxicillin

3 g

Cefuroxime

1000 mg

Cephalexin

3 gm

Ciprofloxacin

1g

Nitrofurantoin

400 mg

Norfloxacin

400 or 800 mg

Sulfisoxasole

2g

Trimethoprim

400 or 600 mg

Trimethoprim/sulfa

2 DS tablets

One-day treatment has been suggested (Table 21.8), but this is less effective than 10-14-day treatment. Three-day treatment is usually effective in curing simple UTIs.

Some experts believe that the standard of therapy for treatment is trimethoprim/sulfa for three days.47 However, the number of E. coli isolates that are resistant to ampicillin, carbenecillin, tetracycline, and trimethoprim/sulfa varies from area to area, but is increasing, so that medication choice may be affected. Fluoroquinolone resistance is still less than 5% in most E. coli populations.48 Instead of trimethoprim/sulfa or ampicillin as a first choice, a fluoroquinone, nitrofurantoin, or cephalosporin maybe a better first choice.

For severe pain, pyridium (100-200 mg three times daily, orally) may be used as an adjuvant for one to two days. Pyridium is a bladder anesthetic and relieves the dysuria immediately. However, it should not be given to patients with renal failure or for more than two days. Patients should be reminded to continue to take the antibiotic, even if the pain is gone. Patients should be advised that pyridium turns urine, and sometimes even sweat, bright orange.

Repeat culture or at least a urine analysis is wise, two to three weeks after infection, to prove sterility and cure.

Recurrent infection

Approximately one-quarter of women will have a second UTI within six months of their first UTI. Most immediate recurrences are reinfections, so a different antibiotic should be used.49

First, the present UTI must be treated with antibiotics. Because the woman (and her bacteria) have already seen one antibiotic, a different antibiotic or one chosen after obtaining sensitivities should be used. Antibiotics should be used for 10-14 days.

Table 21.9 Antibiotic doses for prophylaxis of recurrent urinary tract infections

Antibiotic

Dose for daily use

Dose for postcoital use

Cephalexin

250 mg

250 mg

Nitrofurantoin

50-100 mg

50 mg

Sulfamethoxazole

500 mg

500 mg

Trimethoprim/sulfa

1/2 DS tablet

1/2 DS tablet

Ciprofloxacin

250 mg

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